My Unassisted Home Birth

---Background Info---
I had a wonderfully easy and uncomplicated pregnancy. I had an unassisted pregnancy (meaning I did not see any medical professionals before, during and after birth), focusing on keeping myself and my baby healthy with diet and exercise. I was nice and busy with home births throughout my pregnancy and was at one 10 days before my own home birth!
I had Braxton Hicks (BH) contractions from when I was about 20 weeks pregnant. They were always noticeable, never painful and sometimes surprisingly strong. So I’m not sure when the BH changed into labour contractions. I could have been in early labour for a few days before my labour actually started, but I don’t know because there was never a change in my BH at all that could have clued me in to the fact that I was very close to giving birth.

From about 33 weeks, Taya assumed a right occiput transverse (ROT) position, sometimes turning left OT. She never went into an occiput anterior (OA) position towards the end of pregnancy. My placenta was low, anterior and on the left of the uterus. This made it difficult for her to turn LOA. I constantly tried doing spinning babies exercises to help her assume LOA position, which is considered to be the optimal position for birth. But I ended up just telling her to assume the best position for me and her to have the best birth possible, even if it wasn’t LOA.

I was very calm about carrying Taya for 42 weeks, and did not have any expectation to give birth before then. But I think I did know somewhere in my head (but suppressed the idea to avoid disappointment) that I would give birth much earlier than 42 weeks.

---Labour Day---
On Saturday, 3 December, at 37 weeks and 1 day pregnant, David and I went to town to visit my sister and brother-in-law. We made a detour and walked through a local Christmas market where we bought a pink owl-cat teddy (we didn’t know we were having a girl, but we took it anyways…). We visited with my sister and brother-in-law for a while, sitting in their lounge. I was on their couch when I got uncomfortable because Taya suddenly started moving around, punching like crazy. I decided to go sit on their ottoman, which I knew was usually more comfortable for me anyways. After about 30 seconds, I felt a lot of pressure and a sudden release of fluid! I stood up a bit and it kept running out. I was pretty sure it wasn’t pee… My sister got me a towel and very excitedly, David and I headed home. This was probably around 13h00, but I’m not sure.

That was very unexpected. Not just that my water broke when I was only 37 weeks pregnant, but that my water broke first as a sign of labour! I was hoping for my water to break at the very end of labour… In the car home, I told David about pre-labour rupture of membranes (ROM), and said that it could still be a while (meaning days) before I go into labour, since I had no other signs of labour. We also realized that we hadn’t decided on a name for a boy yet…

We got home and started cleaning the house. Because I was expecting her much later that 37 weeks, we weren’t really fully prepared for the labour. I decided to PV myself (this was probably around 14h00)(I wish I hadn't) just to see if I was dilated at all or not. I was 2cm dilated, with a very soft cervix that was about half a cm thick. Taya’s head was very high, station about -2. I hadn’t seen any show in the days leading up to the labour and also didn’t see any when I PVed. I told David that it could still be really long, as her head was very high.

We headed back to town to finish things at church that needed to be ready for the next morning’s service and to buy food, as I hadn't eaten since breakfast and was quite hungry. As we were shopping, I started having one and sometimes two contractions in ten minutes. They didn’t last very long, but they were very strong. I felt them as “period pain” coming and going (a description of contractions I’ve heard thousands of times over from my time as a midwife in a government hospital). I just leaned over the trolley while I was getting contractions. After we left Spar around 16h00, I suddenly had no appetite at all. That’s when I started thinking that I was going to give birth that day.

We arrived home again and finished sorting the house out, and took one last picture of my pregnant tummy. I remember exactly at 16h37, I wanted to send a few friends a message that my labour was picking up, but I just decided to put my phone down (and then I didn’t pick it up again until the next day somewhere). I suspect that’s when I went into active labour. I never timed my contractions, so I can just say roughly how long and far apart they were. I started having two to three contractions in ten minutes that lasted about half a minute and required me to stop what I was doing and bend over on a counter or whatever I was close to. The contractions got intense very suddenly. It went from maybe I’ll give birth tomorrow, to this baby is gonna come very soon!

We moved into our room, pulled the curtains closed and started playing music (Hillsong’s Empires album, minus the songs Rule and Empires). I went from leaning over the back of a chair to a knee-chest position on the bed to lying on my side on the bed and back to the chair over and over again. The contractions never were more than three in ten minutes and didn’t last extremely long (maybe 40 seconds max, maybe a minute; I’m not really sure). I also had very long breaks in between the sets of contractions. Somewhere I decided to check out my purple line. It was very high, maybe 1.5 cm away from the top and it was bright red, not purple. I then thought that this was gonna be over quickly (meaning an hour or so). I started vocalizing a bit with contractions, just low moaning sounds. My back was a bit sore now and then, but back rubs did not do it for me. David was praying over me during the contractions and he just held me mostly. I liked having him close. I realized that I was thirsty and asked him to make me red raspberry leaf tea mixed with apple juice (hoping that the tea would do it’s trick and make me fall asleep and wake up pushing like I’d heard happened to one woman). (I had only eaten breakfast that day and also didn’t drink much at all… Not smart.) I also started praying that the labour would finish quickly, because it was turning out to be much more effort than I’d expected. I had the urge to push with one of my contractions (this was between 17h00 and 18h00) and felt a bit nauseous, but never to the point of vomiting. The “period pains” were also becoming much stronger with each contraction and I had expected a totally pain free labour. I told David that I wanted to get into our bath tub and that he can fill it up with warm water for me. I was not planning to give birth in water and I also told David before I was in labour that it was unnecessary to set up my birth pool.

Around 18h00, I got into the bath tub. It was nice, but nothing special. I went through the contractions in the tub for an hour when it got quite uncomfortable (it’s hard and has very limited space to move around in easily) and David asked if he could set up my birth pool. I said a very emphatic yes. It was actually very unfair of me to ask him that so late in labour, since it usually takes me about 3-4 hours at a home birth to set up and fill up. David did his task amazingly and it ended up taking him about an hour and 40 minutes. While he was setting the pool up and I was alone in the bath, I had a lot of thoughts running through my head. I was thinking about pain relief and went through the different options. I thought about Pethidine and how stupid I think it is, that it doesn’t do anything beneficial. I was even getting mad at Pethidine for being so useless. I then also thought about Buscopan and wondered if I could get someone to come and give it to me. I wondered if I could call my doula friend to come over to give me tips and help me with positions that would let the baby come out faster, but I imagined her just saying that by the time she gets to me the baby would already be out. Somewhere I PVed myself again and felt that I was about 6 or 7cm dilated, but the head was not descending nicely; it was still at -2 or -1. The high head got me a bit discouraged and I thought that this was still gonna take very long. I never tried to feel for her head’s position. Taya was kicking nicely during labour to assure me that she was fine. I never checked her heartbeat during labour.

I was vocalizing much louder (but I still kept the sounds low and made sure I wasn’t tensing my mouth or shoulders up) and started wondering what the neighbours were thinking… I was also praying much more fervently that the baby’s head would get down. David popped in to check on me regularly and pray while he was setting the pool up.

I had a flashback sometime to the miscarriage, as I had also laboured in the bathroom. I chose not to dwell on that memory.

I felt very present in my mind and logical during the whole labour. I never felt spaced out or out of control at any point. Despite this, time felt like it went by so quickly. Each time I asked David what time it was, I was super surprised that so much time had gone by already. So my labour actually felt very fast to me.

I started pushing while I was in the bath tub. I’m not sure if it was my body telling me to push or me just deciding that I want to get her head down. I didn’t push with each contraction and also not during the entire contraction. One thing I learnt very quickly was that pushing felt very, very good! It made the “period pains” disappear totally! Only thing was that pushing was quite tiring, so it was difficult to keep it up…

Her head descended very suddenly (I guess at this point that her rotation from ROT to OP to LOA was complete and that there was nothing else in the way, so it descended very easily) and I attempted to push my cervix over her head while I was pushing with contraction. It wasn’t painful at all, and I don’t think I was doing it properly. I was more just feeling how her head was descending as I was pushing. When her head came down to my perineum, it didn’t come down any further for a long time. I played with the idea in my head to call my home birth midwife partner to come and cut an episiotomy (this was just one of the unreasonable type of thoughts that can come with being in transition). Talking about transition, I don’t know when mine started. I think I had a very long transition possibly, but I’m not sure. I never felt like I was dying though, and I never felt like I couldn’t do it anymore and that I need to be taken to the hospital. In fact, throughout the whole labour I was very happy that I didn’t have to be in a hospital. I could be naked and make whatever noise I wanted and have all the lights off and do whatever I wanted.

I was constantly praying that I wanted the labour to be over. I think because I knew what the signs of imminent delivery were, I was trying to force it on myself. I knew that when most women say they can’t carry on anymore, the baby is usually very close to being out. So I was praying things like that on purpose, I think. I also wondered at one stage where the endorphins were and why they weren’t relieving my pain (after the labour, I had a bruised forehead for a week from resting my head on the hard side of the bath between the contractions, and I never felt any pain there during labour, so the endorphins were definitely there!).

I was also very confused about the pain I was feeling. I wondered what caused it; was it sin that I needed to repent of, was I actually fearful somewhere in the back of my mind? I didn’t think about that for too long, and then just carried on going through the contractions. I was constantly changing position in the bath. I was on my knees sometimes, sometimes on my side and sometimes I stood up in the bath. I blew out the candles that David had lit for me and I mostly had my eyes closed.

Then at 21h00 David came and told me the birth pool was ready. I was extremely happy about that. He helped me out of the bath and I got a contraction as I was getting out. My arms were around his neck and I buried my face in his shoulder. I swayed with the contraction. That was the most pleasurable contraction I had. It felt amazing to hang onto him. Then I got into the birth pool. Sinking into the deep, warm water and resting on the soft floor and sides of the birth pool felt like heaven at that stage. I floated around and turned over just to enjoy the weightlessness. Soon a contraction came and I started pushing with it. Pushing was so enjoyable for me. It just made everything feel better. After the first contraction, I felt all the muscles in my legs were on the verge of cramping! I always felt so sorry for women in the hospital who would start pushing their babies out and then get cramps in their legs as well. I felt that dealing with muscle cramps at that point in life was so unfair.

I knew that I needed to hydrate myself. I told David to make me Empact and mix Nutriverus in. I downed it very quickly and felt better after that. My muscles never cramped.

Her head crowned very gradually, but I was content. I wanted time for my perineum to stretch nicely. I told David to feel her head as well. I was leaning on the side of the pool with my head, on my knees and using my hands to support my perineum wherever I felt it was burning. I also stopped pushing as soon as I felt a burning sensation. When her head was out up to her ears more or less, I decided to stop pushing for a few contractions, just to slow things down even more. I thought to myself that I really don’t want stitches, so I have to take it very slow.

Then a point came with one of the contractions where I just decided that this baby is coming out now. I carried on pushing and felt her head pop out. I felt a cord around her neck, but it was loose, so I thought she’d just come out with it and we’d loop it over her head after she was out. I tried pushing her shoulders out with two contractions, but I didn’t really feel anything happening. With the next contraction, I decided to lift her head up toward the roof to help the anterior shoulder be released. Her shoulders came out easily then, but they were more painful than her head. Her body glided out nicely, and David said that the cord was looped around her neck twice, and that one of the loops was very tight. I told him to just pull them over her head (she was still under water), which he did easily, then I lifted her onto my chest and just breathed a sigh of relief and relaxed. She was out at 21h45. She didn’t cry at all, but her muscle tone was good, so I knew she was fine and happy. The lounge was lit by candles, so it wasn’t easy to see her colour. We heard her soft breathing that was a little whimper sometimes. I just put my head back and was so relieved to have it all over. After about 5 minutes we remembered to check if we had a boy or a girl! We were overjoyed to see that our baby was a girl!! David got oil and prayed over our baby (I can’t remember if this was before or after we checked the gender). A while later David said we should just check again to make sure it’s a girl. She was indeed our baby girl. Although we never said our preference during my pregnancy and insisted that we didn’t have a preference, we both actually wanted a girl. And she had a full head of hair!!! I was so happy about that as well.

After about 15 or 20 minutes, I felt a contraction again and saw blood in the water, meaning that my placenta had detached. I started pushing immediately and I pulled a little on the cord just to make sure the placenta was really detached. When I felt the cord get longer easily, I pushed with all my might to get it out in that one contraction. The placenta came out nice and easily with only one contraction. Then we got out of the pool and walked to the bed where Taya latched on very effortlessly and drank to her heart’s content. She drank on and off for about two hours.

I had quite uncomfortably strong contractions while Taya was drinking. I thought then to massage my uterus (I had minimal bleeding up to that point), which led to two tennis ball sized clots coming out. I felt much better after that. I carried on rubbing my uterus and smelling Taya’s head to encourage my uterus to contract. I had let Taya crawl to the breast herself, so she was also helping my uterus to contract with her kicking and sucking. I filled two linen savers up with blood. I asked David to feed me dates to also help my uterus to contract. I wasn’t that worried about the amount of bleeding. After about 4 hours, David cut her cord and I walked to the bathroom to pee. After my bladder was empty, the bleeding was much less. I saw myself in the bathroom mirror and I looked very weird without my huge tummy, which was now hanging very loosely below my belly button. My upper abdomen was sunken and I looked like those pictures of very anorexic girls with their ribs sticking out, except that I had the funny-looking loose lower abdomen.

We then used one of our phone’s torch and the other phone’s camera to help me see how my perineum did. I sustained a labial laceration that, in my opinion, didn’t need suturing. My perineum wasn’t painful at all.

We spent the rest of the night totally relaxed and happy, staring at our perfect baby girl. We managed to fall asleep around 4am.

---Afterthoughts---
I think my labour was amazing. I just get good feelings (and a milk letdown) when I think back to it. Even though it was much harder work than I expected and I didn’t experience a totally pain-free labour, I loved it. I would do it again any day.

I was sad that my water broke so early in labour. It could have happened because of Taya’s position (posterior babies sometimes have an early ROM). I hope for my future labours that my water breaks right before the baby comes out. Contractions are usually less intense if the membranes are intact.
I think her shoulders caused the laceration. I also realized that I should have tried changing positions first to release her shoulders. My medical midwifery training just kicked in there causing me to do what I was taught instead of just doing something as natural as lifting one leg up, which I really feel would have done the trick.

Considering that Taya had to take the long way around from ROT to LOA, I actually had a very fast and easy labour. It could also be that my uterus had to contract much more powerfully to get her into the right position for descent. The cord that was around her neck twice could also have kept her high up and prolonged her labour (keep in mind that I was expecting an hour or two of contractions and a totally effortless labour; I know a 5 hour long labour is not long at all).

My biggest mistake was not eating or drinking during the day before my labour started and not staying hydrated during labour.

My advice to any other midwives who want to give birth at home… Do not PV yourself. Just let labour happen and keep assuming that you’re only 3 or 4cm dilated. I think that PVing myself caused fear and discouragement to come in a bit. It’s fine when the head is crowning to keep a hand or two there, but don’t assess yourself. I won’t do it in future labours (I don’t PV my home birth clients anyways unless it’s requested or I think it’s very necessary).

Why did I have pain in labour? These are my theories.
I was dehydrated and hungry. Imagine arriving at a marathon that starts at 5pm and you only ate breakfast and had nothing to drink the whole day…
I got discouraged when I felt how high her head was.
I didn’t deal with my feelings during labour. I think I was afraid to admit any fears or negative feelings. It might have changed a lot if I’d voiced how I felt about her head being high, the intensity of the contractions and fear that my labour was going to take very long. Then I would have had it out in the open and truth could be spoken over me.
I kept postponing and never got to writing and putting up any affirmations.
Maybe her position led to very strong contractions attempting to turn her into the right position for exit.
I think my abdominal muscles also played a part in keeping Taya from assuming an OA position before labour. I had a six-pack from the age of 9 and maintained it for my whole life. During pregnancy, I was overly anxious about developing diastasis recti (separation of abdominal muscles) and did a lot of core exercises and nearly constantly had my stomach muscles engaged, even when I wasn’t exercising. The near constant pulling-in of my stomach could have reduced the space for Taya to lie with her back to my tummy and then held her in that posterior position.

So all things considered, I had an amazing labour. I thank God for it regularly. I am so grateful that I gave birth at home with only my husband present. Throughout my labour, I never doubted our decision to give birth unassisted at home.